Tian Huan-huan, Han Sha-sha, Lv Chang-jun, Wang Tao, Li Zhi, Hao Dong, Shang Quan-mei, Wang Xiao-zhi
Binzhou Medical University Clinical Department, Binzhou, Shandong, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Jan;24(1):42-5.
To observe the clinical effects of 10%, 30% lactate clearance rate and early goal-directed therapy (EGDT) as 6-hour resuscitation goals directing treatment in septic shock patients with severe pneumonia.
In this randomized, perspective study, septic shock patients with severe pneumonia were divided into control group and experimental group, which included 10% lactate clearance rate group and 30% lactate clearance rate group, adopting random number method. The control group was treated with 6-hour EGDT strategy, and the experimental groups were treated with 10% lactate clearance rate protocol and 30% lactate clearance rate protocol respectively, beside the EGDT.
There were 19 patients in control group, and 43 patients in experimental group, which included 22 patients in 10% lactate clearance rate group and 21 patients in 30% lactate clearance rate group. Patients were well matched by basic features. After 48 hours, the acute physiology and chronic health evaluation II (APACHE II ) score of both 10% lactate clearance rate group (13.76 ± 6.00, P < 0.05) and 30% lactate clearance rate group (13.60 ± 6.18, P < 0.05) were lower than that of control group (18.15 ± 6.62). There were no differences in time of mechanical ventilation (hours) between control group and experimental group (10% group 136.90 ± 100.02, 30% group 97.00 ± 75.20, control group 152.32 ± 96.51, P > 0.05). The length in intensive care unit (ICU, days) of 10% and 30% lactate clearance rate groups were significantly shorter than control group (10% group 7.94 ± 6.00, 30% group 7.51 ± 3.99, control group 11.31 ± 5.97, both P < 0.05). The three groups had no differences in 7-day mortality rate (10% group 18.18%, 30% group 14.29%, control group 21.05%, all P > 0.05), but the 28-day mortality of 10% and 30% lactate clearance rate groups were significantly lower than control group (10% group 36.36%, 30% group 28.57%, control group 63.16%), especially in 30% lactate clearance rate group (P < 0.05).
For the septic shock patients with severe pneumonia, prompt archiving EGDT strategy and 6-hour lactate clearance more than 30% were associated with an optimal outcome.
观察以10%、30%乳酸清除率及早期目标导向治疗（EGDT）作为6小时复苏目标指导治疗对重症肺炎脓毒症休克患者的临床效果。
在这项随机、前瞻性研究中，采用随机数字法将重症肺炎脓毒症休克患者分为对照组和试验组，试验组又分为10%乳酸清除率组和30%乳酸清除率组。对照组采用6小时EGDT策略治疗，试验组在EGDT基础上分别采用10%乳酸清除率方案和30%乳酸清除率方案治疗。
对照组19例患者，试验组43例患者，其中10%乳酸清除率组22例，30%乳酸清除率组21例。患者基本特征匹配良好。48小时后，10%乳酸清除率组（13.76±6.00，P<0.05）和30%乳酸清除率组（13.60±6.18，P<0.05）的急性生理与慢性健康状况评分II（APACHE II）均低于对照组（18.15±6.62）。对照组与试验组（10%组136.90±100.02，30%组97.00±75.20，对照组152.32±96.51）机械通气时间（小时）差异无统计学意义（P>0.05）。10%和30%乳酸清除率组的重症监护病房（ICU）住院时间均显著短于对照组（10%组7.94±6.00，30%组7.51±3.99，对照组11.31±5.97，均P<0.05）。三组7天死亡率差异无统计学意义（10%组18.18%，30%组14.29%，对照组21.05%，均P>0.05），但10%和30%乳酸清除率组的28天死亡率显著低于对照组（10%组36.36%，30%组28.57%，对照组63.16%），30%乳酸清除率组尤其明显（P<0.05）。
对于重症肺炎脓毒症休克患者，迅速实施EGDT策略及6小时乳酸清除率超过30%与最佳预后相关。
